I first met Mary twelve (12 ) years ago, through one of her daughters, she was eighty (80) years of age with three daughters and two sons. Mary was short, and a little plump, full of life, and active in the community where she lived. The years that I visited a relationship developed, but really, got to know her with each visit. A couple years later, her husband made the decision to move, from an apartment, to a Nursing Home, where their every needs could be met, but still have the freedom to come and go as they pleased, soon after the move her husband died, and one of her daughters also. Although it was painful for her she had a very good support system in place. Within the time of her husband's death and moving they both made out a Living Will, and all the necessary legal paper work.
The Diagnosis:
Mary was diagnose a year later after her husband's death, with bone Cancer, and yes it was a blow to her, and could not imagine how she got Cancer, especially bone Cancer, but talking to her, she said that it ran on her side of the family, because two of her sisters, died from cancer.
The Treatment:
Mary had to undergo radiation treatment twice a week for twelve weeks, and it showed every time she finished a treatment, which left her weak at times, after the treatment she regular checkups to make sure the cancer was not spreading too fast, after two years, the Doctor's were satisfied that the cancer, had reduced in sized.
After the radiation treatments, Mary had regular check ups, at the Cancer Hospital, to see if the cancer was spreading, but found out that it was not, and was given the okay to continue doing what ever she wanted to do, with help from medication it helped with keeping the cancer at bay. Mary knew that the cancer could return at anytime, but continues to live her life the way she had always done. Two and a half years ago the cancer returned, and progressed to the point, that Mary did not want to undergo any radiation treatment knowing how it had affected her energy level.
Side Effects:
Mary showed signs of that of a sick person, lacking energy,and not wanting to do anything or go anywhere. She was contented to satay in her room, watch TV, read and knit, she said that she feels okay, but the signs on her face said otherwise, all that was due to the heavy medications she has to take to help her through the day.
My Observation:
I visited Mary about twice a week, and on one of my visits with her daughter, noticed she was looking rather pale and was not up to par, and mentioned it to her daughter whom I went with that day, she immediately made an appointment for her to see the doctor. Mary was told that the cancer had returned and progressed faster than ever, and gave her about four months to live.
Advance Directives:
The progression of the cancer gave Mary a scare, and had asked her eldest daughter to get her Living Will updated, and make any changes that were needed, and also to be the Power of Attorney. The other form that was also written out was the Values History Form, which addresses all that was needed in case of any serious implications knowing that she had only a few months to live.
Technology Equipment:
The look on Mary's face said it all it showed signs of frailty, and her breathing was helped with the aid of pure oxygen, which helped in a way, but was uncomfortable having by the air hose in her nostrils. Mary also had the use of an air mattress, which helped her to feel comfortable while laying on her back to ease any pains.
Medical and Caregivers:
Although Mary was given medication for her pain, she also had a good team of Caregivers that saw to her every needs, twenty- four seven (24/7 ) she had the best care that could have been provided, and was well
looked after, she was waited on, and was granted anything that she wanted to eat or drink at anytime day or night.
Family Involvement:
During the last couple weeks before Mary's death, she had round the clock attention by her family, everyone doing their part to be with her. I had the chance to spend twelve hours with her, tending to her every needs,and doing what ever I could to make her as comfortable as possible. They were always family around her, and music playing softly in listening range. As the time drew near the Priest from her Church was called, to anoint her with Holy Oil, which is part of the last rites for many Christians that were dying. The family made the decision that the oxygen should be unplugged, and let her breathe on her own which was one of the stipulations written in her Values History.
Death Song:
As Mary lay on the bed of her last days, the death song were being played constantly, the gasping for air, wheezing of her lungs, the asking for something to drink, and that her lips be kept moist, what was most discomforting for her was the constant itching she had from laying on her back which had to be rubbed with cream to relieve some of the itching. It was so sad to see the person that was so active, and full of life lying on her bed awaiting death, the skeletal frame of Mary, with her eyes sunken into her sockets was seen as a fragile individual awaiting a death sentence. Mary died two days after, during the night in her sleep a good death knowing that her family was with her when she died.
Preparation:
Lets take a look at Mary's life and the planning she did on or before her death. We know that she and her husband, made a Living Will, and that Mary had amended parts of it to reflect what she wanted happen after her death. Although they both planned ahead preparing for each other, and did not leave any burden on their children, which was well though of.
The consensus is that the general public on the whole, thinks that an Advance Directive is not required at the very moment. The thought then, is nothing is going to happen to me, for the most part is the way people think, until something major happens, like an accident where it is very serious, and they are facing the End of Life.
If we think, about what we know about illness, death and what there is to do, why? are so many of us fail to plan for the End of Life, is it that we need to be more educated on the subject, or are we just acting ignorant to the fact that we just don't care about those things right now. By planning for what may happen in our lives, it makes sense, to have in place Legal Documents, that our children knows about, and what our wishes are in case there is an emergency, when we cannot communicate or make decisions for ourselves.
These legal documents include, a Living Will and Health Care Proxy also known as a ( Durable Power of Attorney.) Since wishes are communicated through the Advance Directive we should also have Values History Instructions which is optional. What is included in an Advance Directive?
Directions that lets the Medical Team knows the treatment that the patient want done, and do not want in case of extending or shortening life in any terminal conditions.
That there is a person designated to make decisions for the person, if they are hurt in an accident or incapable of doing so.
The kind of comfort care he/she decided, such as reducing pain,and suffering.
Preference based on his/her religion.
Mary made sure that all Legal Forms were signed, and all that was needed to take care of the burden that was going to be left for the children to sort out. They can now look forward of taking care of her wishes,and desires that were on the Advance Directive.
Mary's story was simple, with all the Legal and Financial Documents signed, and other important papers made available to her eldest daughter, she could rest, and be assured that her wishes for everyone and herself would be carried out. We know that death is certain, but we do not know the time, place or how it is going to happen, when the river of life runs smoothly, and suddenly there is a stone (illness) that disrupts everything it is definitely not the time to start thinking about an Advance Directive.
The Advance Directives answered all of what Mary wanted, and together with the Power of Attorney every thing possible was done to make her very comfortable. Mary I must say died well, and had a good death, with her family gathered in her room, and had a Priest anointed her with Holy Oil, which is the last rites , for a dying person of Christian faith.
What I should point out here was the Caregivers understanding of the family concerns, and they catered to Mary and the family every needs, everyone that worked with Mary, showed such patience when she did not want the oxygen hose in her nostrils, which was removed no questions asked, because the answer to that question was already filled out in her Values History Instructions.
Managing pain was foremost on the mind of children at this stage, and pain management was helped by medication. Mary's smile could be seen on her skeletal frame as her loved one told her how much she would be missed, and was loved. She left this world knowing she was loved, missed and her children, grand and great grand children would be taken care of, as stipulated in her will. I will say this, that it is very important to have all Advance Directives made out ahead of time, and signed just in case some misfortune happens.
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